restricts the development of vital cognitive, social and communicative ... Furumasu, Tefft, Guerette in U.S .... and getting mobile through learning tool use. Slow.
Powered Mobility for Young Children
What does the research tell us? Lisbeth Nilsson, PhD and specialist OT Associated to Lund University Sweden
Impact of impaired mobility Nisbet (2002). Technology and Disability, 14(4), 173-182
Assessment and training of children for powered
mobility in the UK. ”Lack of physical movement prevents the acquisition of
basic physical skills, but perhaps more importantly, reduces opportunities for play and for exploration, and restricts the development of vital cognitive, social and communicative skills. The result is a ”cycle of deprivation”, which damages the child’s very ability to learn and develop.” (p 173)
Decades of research Benefits and products for early powered mobility Examples of research teams: 1980 Charlene Butler in U.S. 1990 Odor & Nisbet in Scotland Stott & Sanders in U.K. Furumasu, Tefft, Guerette in U.S Nilsson in Sweden 2000 Durkin in U.K. Galloway in U.S. Dennis in U.S.A. Livingstone, Field in Canada 2010 Takashio, Masuda in Japan
Early powered mobility Agreements Important to experience
self-controlled mobility in early years Achievements – perceptual-motor skills, psycho-social, emotional and cognitive development Just get moving!
Typically developing infants - study in 1997 Infant 3-months and 10 days old – exploring use of hands and possible effects of acting on the joystick – she quickly gets the idea that movement of the chair is caused by the joystick
Achievements Guerett, Furumasu & Tefft (2013). In Assistive Technology, Spring;25(1):39-48 The positive effects of early powered mobility on children's psychosocial and play skills.
23 children with physical disabilities aged 18 months to 6 years Cognitive and psycho-social impact: Six months after provision of a powered wheelchair showed increases in social skills and in mobility during indoor free play. The children also more frequently shifted in-between tasks (as they could do so). Outdoor interactive free play improved in quality.
Early powered mobility Disagreements Readiness or development? Joystick or other controls? Overriding remote control Free driving or half-automatic systems Size/design of devices Quick fix or learning process? Assessment of skills or process?
Readiness or developing skill Hardy, P. (2004). Australian Occupational Therapy Journal, 51, 34–42. ● Powered wheelchair mobility: An occupational
performance evolution perspective. Citation: “While clinicians endeavour to quantify skills necessary to operate a powered wheelchair it is likely that many skills previously considered ‘prerequisites’ for mobility are actually developmental achievements occurring as consequence of mobility. Research reveals a critical link between independent mobility developed in the first 3 years of life, and development of certain psychological and cognitive perceptual skills in young children.”
Infant 5 months, typically developing Explores relationships in the environment through free driving, shows interest and happiness
Joystick or other controls Joystick Nilsson & Nyberg. (1999). Technology and Disability, 11, 35–38.
● Single-switch control versus powered wheelchair for
training cause-effect relationships: case studies. Showed that a proportional (analogue) joystick worked better for children at an early developmental level Review of different controls Henderson, Dolan & Geggie (2013). Technology and Disability, 25(4), 221-232
A review and appraisal of clinically prevalent control
devices for electrically powered wheelchairs. Provides a summary table displaying pros and cons of different controls (p 228)
Overriding remote control or not? Pros Safety Playful use with a child that is misbehaving/teasing/playing Agreement about expected performance involving the consequence that power circuits are cut if not sticking to what is agreed (child, teenager) Cons Barrier for learning at an early developmental level Disrupt stable experiences of cause-effect relationships Hinder development of awareness of a predictable joystick function pattern
Alternatives: Practice in a robust environment and use of equipment that allows “safe” collisions Hand-over-hand guidance and/or taking hold of the equipment from behind to slow down or stop Combine with explaining communication/interaction (infant, toddler)
Free driving or half-automatic systems Free driving Nilsson, Eklund, Nyberg, &Thulesius. (2011). Am J Occup Ther. 65(6), 652–660
Driving to Learn in a powered wheelchair: The
process of learning joystick use in people with profound cognitive disabilities. Half-automatic systems (i.e. Smart wheelchairs; line follower; obstacle avoidance; ”fenced” driving) Simpson. (2005) J Rehab Res Dev. 42(4),423–435 Smart wheelchairs: A literature review.
Infant 7 months, typically developing First mutual interaction with toy, when he gets fed up he makes another choice inspired by his curiosity and inquisitiveness of what happens out of sight
Size/design of devices Feldner, Logan, & Galloway (2015). Disability and Rehabilitation: Assistive technology, 11(2), 89-102 ● Why the time is right for a radical paradigm shift in early powered mobility technology devices, policy and stakeholders Child sized equipment Design and provision need to be child-focused User influence on design – looks, size, weight Principles: Adaptive, Flexible, Durable, Low cost, Aesthetic and Accessible
Quick fix or learning process Quick fix – involves approaches taking you as fast as possible
to the goal – getting mobile. Rapid. Learning process – involves active exploration of the powered mobility tool. The goal is cognitive development and getting mobile through learning tool use. Slow. Questions to be answered: Who’s perspective and who’s goal? Who’s frustration and over what? How does the alternatives affect the outcome? What is most interesting, a short-time or a long-term benefit?
Assessment of skills or process Assessment of skills
ticking off a list of described actions connected to powered wheelchair operation ex.: PMIDA Assessment of process marking up indicators for actual phase in the process of learning powered mobility use ex.:ALP tool (instrument and facilitating strategies) Nilsson & Durkin (2014). Journal of Rehabilitation Research and Development 51(6), 963-974
Assessment of learning powered mobility use—Applying
grounded theory to occupational performance
2 year old, multiple and complex disabilities A clip illustrating how the performance can oscillate between phases in the process of learning joystick use and powered mobility use
ALP – instrument (Nilsson & Durkin, JRRD, 2014) 7
Multi- channelled attention Generally focused
Occupation for its own sake
Fluent precise use of tool Happiness Satisfaction
Concurrent interactions
6
Multi-channelled attention but easily disrupted
Activity
Serious Contented Laugh Excited
Consecutive interactions
Goal-directed
Competent use of tool
5
Two-channelled attention
Sequences of chains of acts
Idea of competent tool use is born
Eager, smile Serious Frustration
Reciprocated interaction Triadic interaction
4
Single channelled attention but able to shift spontaneously
Chains of acts
Exploration of extended tool use
Serious Smile Sometimes laugh
Mutual interaction
3
Single channelled attention but able to shift attention
Act
Basic use of tool
Serious Contented Smile
Initiates interaction
2
Single channelled attention
Pre-act
Idea of basic tool use is born
Contented Curious Anxious Angry
Responds to interaction
1
Extreme distractibility Passive or anxious
Excited Non-act Rejection
No or vague idea of tool use
Open Neutral Anxiety
No response Avoidance
Explore
Dependent on Multi-level integrated the doing of interactions other activities
Explore
Integrated tool use
Explore
Occupation composed of two or more activities
Body, & machine
Attention well established and sustained
STAGE
FUNCTIONS
8
directed
Interaction & Communication
SEQUENCING
Expressions & Emotions
PERFORMANCE
Understanding of tool use
Body, machine, & environment
Activity & Movement
Body, machine, environment, & occupation
Phase Attention
Benefits of learning process Stimulates drive and motivation
Fuels curiosity and inquisitiveness Excites initiative and explorative behaviour Encourages experimenting and problem-solving
Builds up an approach for how to meet novel situations with new tools or new procedures Gives confidence to agree to new challenges Develops/expands engagement in occupations and participation
Ongoing intervention/product research Baby loco – Takashio, PT, Yasuda Engineer, Japan Kids loco project: http://www.mech.usp.ac.jp/~maw/KL_HP/index.html Kids loco, Carry loco and Baby loco: http://www.mech.usp.ac.jp/~maw/research01.html Video Carry loco: https://www.youtube.com/watch?v=Mib88gkWxko
Ongoing intervention/product research Examples: Go-baby-go – James C. Galloway, PT, US http://www.udel.edu/gobabygo/index3.html Baby robotics – James C. Galloway, PT, US http://www.udel.edu/research/media/babiesrobots.ht ml
Ongoing intervention/product research Examples: Driving to Learn in Tiro – Lisbeth Nilsson, OT, Sweden http://www.lisbethnilsson.se/en/
Ongoing intervention/product research Examples: Wee-bot – Carol Dennis, OT, US http://faculty.ithaca.edu/cdennis/ http://www.nbcnews.com/id/48752647/ns/healthchildrens_health/t/how-baby-driven-robots-could-helpdisabled-children/#.Vqctfk_09B4
Ongoing Driving to Learn research Eastern Swiss Children’s Hospital, Switzerland - started 2015 Powered mobility training for young children
with disability
Children with cerebral palsy, aged 2-4 years A time series design (A-B-A-B-design) with repeated measures. Phase A (control phase, four months, no powered mobility training) Phase B (intervention phase, four months of powered mobility training with weekly session, 45 to 60 minutes each, based on Nilsson’s work about the Driving to Learn method and the works of Durkin and Nilsson involving outcome assessment and facilitating strategies of learning powered mobility use.
Infant 4 months (typically dev) testing Tiro Focused on exploration, don’t care about all people and noise around him. Experimenting with different grasps. Turns to test with the other hand in the end of the clip
Reflections Fun and play provides development and learning
for life Mobility provides opportunities for play and participation Important to grow awareness of pros and cons regarding existing mobility alternatives But, most important is to get mobile as early as possible!
